Can Repairing Your Brain’s Wiring Help You Fight Addiction?

U.S. opioid deaths are soaring as the costs of drug abuse approach $200 billion a year. Neuroscience offers new ways to fight the epidemic.

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At Cabell Huntington Hospital in Huntington, West Virginia, Jordann Thomas, 28, holds her five-week-old son, who was born with neonatal abstinence syndrome (NAS), a state of opiate withdrawal. Thomas, who’s in recovery from heroin addiction, says she became pregnant while using a withdrawal support drug that crossed the placenta and caused her baby’s NAS. The syndrome has become so common that the hospital’s ward devoted to it often has more infant patients than beds. Photograph by MAX AGUILERA-HELLWEG

This story appears in the
September 2017 issue of
National Geographic magazine.

Every 25 minutes in the United States, a baby is born addicted to opioids.

That heartbreaking statistic is but one symptom of an epidemic that shows no sign of abating. The 33,000 overdose deaths from opioids in 2015 were a 16 percent rise over the previous year, which also set a record. Drug overdoses are now a leading cause of death among Americans under 50—but only part of a broader addiction landscape that ranges from drug and alcohol abuse to obsessive eating, gambling, and even sex.

For this month’s cover story, “The Addicted Brain,” we went in search of the “why.” Why do human beings get addicted to substances and behaviors we know will harm us? What can new research tell us about addiction and the brain? Most important: Can what we’re learning help more people recover?

“Not long ago the idea of repairing the brain’s wiring to fight addiction would have seemed far-fetched,” medical writer Fran Smith reports in our story. “But advances in neuroscience have upended conventional notions about addiction—what it is, what can trigger it, and why quitting is so tough.”

The very nature of addiction is being rethought. In 2016, when he was U.S. surgeon general, Vivek Murthy—who’s interviewed in this issue—affirmed what scientists had contended for years, as Smith says: “Addiction is a disease, not a moral failing. It’s characterized not necessarily by dependence or withdrawal but by compulsive repetition of an activity despite life-damaging consequences. This view has led many scientists to accept the once heretical idea that addiction is possible without drugs.”

Still, drug abuse takes a huge toll nationwide: nearly $200 billion a year in costs related to health, crime, and lost productivity. Nowhere does this play out more starkly than in West Virginia, which owns what Senator Shelley Moore Capito calls an “unfortunate distinction”: the nation’s highest rate of drug overdose deaths.

Related video: The Science of Addiction

Addiction affects tens of millions of people across the planet. But where does it come from? This animated video breaks down how the brain’s dopamine-based reward system works and how different drugs hijack this system.

A native West Virginian elected to the Senate in 2014, Capito sees the issue in personal terms. “The most heart-wrenching part is that it hits everybody … I’ve been in meetings where they tell you to look to the right or the left and say, ‘That’s what a heroin addict looks like.’ ”

What she’s learned, she says, is that turning the corner will require a spectrum of solutions—everything from more support at the state and federal levels for treatment and prevention programs to more facilities like Lily’s Place, a Huntington, West Virginia, medical center for babies born dependent on drugs.

Seeing the suffering, Capito says, “I’ve learned not to be quite so judgmental.”